2018 Antidote Survey

If you are replying for more than one facility, PLEASE fill out a separate survey for each one.

Address

CityZIP Code

Pharmacy Contact Person Name*

FirstLast

Contact Title or Job Responsibility*

Contact Phone Number*

Contact Email*

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Please check which antidotes your facility stocks.

Acetadote, N-Acetylcysteine (NAC)

Activated Charcoal

Atropine

Calcium Chloride or Calcium Gluconate

Calcium Disodium Edetate (EDTA)

Crotalidae Antivenin – Crofab

Cyanide Antidote – Cyanokit (Hydroxycobalamin)

Deferoxamine

DigiFAB, Digoxin Immune Fab

Dimercaprol (BAL)

DTPA

Ethanol For Parenteral Use

Flumazenil

Fomepizole – Antizol

Glucagon

L-carnitine

Leucovorin

Lipid Emulsion

Methylene Blue

Naloxone – Narcan

Octreotide

Physostigmine, 1 Mg/Ml

Pralidoxime (2-PAM)

Praxbind (idarucizumab)

Pyridoxine Hcl (B6), 100mg/ml

Silymarin

Succimer/DMSA

Vistogard (uridine)

Vitamin K

Voraxaze (glucarpidase)

Other

If a crisis arose and we have sufficient stock, we’d be glad to share.*

Yes

No

The Washington Poison Center (WAPC) provides immediate, free, and expert treatment advice and assistance on the telephone in case of exposure to poisonous, hazardous, or toxic substances. All calls are confidential.

OUR MISSION: To prevent and reduce harm from poisoning through expertise, collaboration, and education.

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